Abuse, Neglect and Post-Traumatic Stress

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.


Childhood maltreatment or adverse experiences in five domains (emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect) have been reported as highly prevalent in patients with binge-eating syndrome. In one study, 83% of patients with binge eating reported some form of childhood maltreatment: 59% reported emotional abuse, 36% reported physical abuse, 30% reported sexual abuse, 69% reported emotional neglect, and 49% reported physical neglect.

Maltreatment, notably emotional abuse and neglect, is significantly associated with depression and low self-esteem, but its relationship to weight, the onset of obesity or to other obesity-related features is less straightforward. Weight may be used by patients (consciously or unconsciously) as a way to push away the world or intimacy.

Post-traumatic stress disorder occurs in a subgroup of individuals exposed to a severe life-threatening trauma. The core set of symptoms are: intrusive re-experiencing, avoidance and arousal. Co-morbid substance abuse and mood and anxiety disorders are common. Trauma-exposed individuals are more likely to engage in behaviours that present a health risk and are more likely to report physical symptoms and functional impairment. A high prevalence of overweight and obesity is found in patients with post-traumatic stress disorder.

It is important to monitor patients with a history of abuse for recurrence of emotions or memories as they lose weight. Before initiating a weight-loss strategy, the possibility of weight-loss distress should be discussed with the patient. This is not an uncommon occurrence and the patient should know you are willing to discuss it with them.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

Members of the Canadian Obesity Network can download Best Weight for free.

Best Weight is also available at Amazon and Barnes & Nobles (part of the proceeds from all sales go to support the Canadian Obesity Network)

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